STATISTICAL PRESS NOTICE NHS REFERRAL TO TREATMENT (RTT) WAITING TIMES DATA JANUARY 2013

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1 STATISTICAL PRESS NOTICE NHS REFERRAL TO TREATMENT (RTT) WAITING TIMES DATA JANUARY 2013 Data are published on consultant-led Referral to Treatment (RTT) waiting times for patients who were treated during January 2013 and patients waiting to start treatment at the end of January Main Findings During January 2013, 92.6% of admitted patients and 97.5% of non-admitted patients started treatment within 18 weeks. For patients waiting to start treatment (incomplete pathways) at the end of January 2013, 94.3% were waiting within 18 weeks. 317,545 RTT patients started admitted treatment and 953,847 started non-admitted treatment during January The number of RTT patients waiting to start treatment at the end of January 2013 was around 2.54 million patients. The average (median) time waited for patients completing an RTT pathway in January 2013 was 9.2 weeks for admitted patients and 4.8 weeks for non-admitted patients. For patients waiting to start treatment at the end of January 2013 the median waiting time was 6.0 weeks. North Bristol NHS Trust and Bradford Teaching Hospitals NHS Foundation Trust did not submit incomplete RTT pathway data for January Detailed tables of waiting times by treatment function (specialty), commissioner and provider are available at: 1

2 Table 1 January 2013 Referral to Treatment (RTT) waiting times by treatment function, England Admitted Pathways Non-Admitted Pathways Incomplete Pathways % within % within % within Treatment function Total (all) 18 weeks Total (all) 18 weeks Total (all) 18 weeks General Surgery 42, % 61, % 240, % Urology 20, % 29, % 132, % Trauma & Orthopaedics 59, % 86, % 350, % ENT 17, % 66, % 175, % Ophthalmology 43, % 86, % 262, % Oral Surgery 17, % 34, % 129, % Neurosurgery 2, % 5, % 23, % Plastic Surgery 11, % 9, % 40, % Cardiothoracic Surgery 2, % % 7, % General Medicine 4, % 23, % 47, % Gastroenterology 12, % 25, % 105, % Cardiology 9, % 41, % 118, % Dermatology 7, % 57, % 122, % Thoracic Medicine 1, % 19, % 48, % Neurology % 24, % 67, % Rheumatology 1, % 20, % 41, % Geriatric Medicine % 10, % 16, % Gynaecology 26, % 64, % 158, % Other 35, % 285, % 448, % England 317, % 953, % 2,537, % 2

3 Table 2 Referral to Treatment (RTT) waiting times, England Admitted pathways Non-Admitted pathways Incomplete pathways % % within within Month Median wait 95th percentile weeks Median wait 95th percentile weeks Median wait 95th percentile March % % within 18 weeks August % % % March % % % March % % % March % % % March % % % November % % % December % % % January % % % February % % % March % % % April % % % May % % % June % % % July % % % August % % % September % % % October % % % November % % % December % % % January % % % Notes: 1. Median and 95th percentile times are calculated from aggregate data, rather than patient level data, and therefore are only estimates of the position on average waits. 2. Where the 95th percentile falls in the over 52 week time band, the estimates are less accurate. Hence, such figures are shown as 52+ weeks. 3. Admitted RTT pathways are waiting times for patients whose treatment started during the month and involved admission to hospital. 4. Admitted (unadjusted) RTT data were first published in March Admitted RTT data on an adjusted basis were first published in March Adjustments are made to admitted RTT pathways for clock pauses, where a patient had declined reasonable offers of admission and chosen to wait longer. 6. Non-admitted RTT pathways are waiting times for patients whose treatment started during the month and did not involve admission to hospital. 7. Incomplete RTT pathways are waiting times for patients still waiting to start treatment at the end of the month. 8. Non-admitted and Incomplete RTT data were first published in August

4 Notes to Editors RESTRICTED STATISTICS For admitted patients, adjusted data (allowing for legitimate pauses of the RTT clock) is used to measure waiting times. Statistical Notes 1. National Statistics The United Kingdom Statistics Authority has designated these statistics as National Statistics, in accordance with the Statistics and Registration Service Act 2007 and signifying compliance with the Code of Practice for Official Statistics. Designation can be broadly interpreted to mean that the statistics: meet identified user needs; are well explained and readily accessible; are produced according to sound methods, and are managed impartially and objectively in the public interest. Once statistics have been designated as National Statistics it is a statutory requirement that the Code of Practice shall continue to be observed. 2. Referral to Treatment pathways and clock stops Patients referred for non-emergency consultant-led treatment are on Referral to Treatment (RTT) pathways. An RTT pathway is the length of time that a patient waited from referral to start of treatment, or if they have not yet started treatment, the length of time that a patient has waited so far. The following activities end the RTT pathway and lead to the RTT clock being stopped: first treatment - the start of the first treatment that is intended to manage a patient's disease, condition or injury in a RTT pathway start of active monitoring initiated by the patient start of active monitoring initiated by the care professional decision not to treat - decision not to treat made or no further contact required patient declined offered treatment patient died before treatment 3. Operational waiting time standards The waiting time standards set the proportion of RTT pathways that must be within 18 weeks. These proportions leave an operational tolerance to allow for patients for who starting treatment within 18 weeks would be inconvenient or clinically inappropriate. These circumstances can be categorised as: Patient choice patients choose not to accept earliest offered appointments along their pathway or choose to delay treatments for personal or social reasons Co-operation patients who do not attend appointments along their pathways 4

5 RESTRICTED STATISTICS Clinical exceptions where it is not clinically appropriate to start a patient s treatment within 18 weeks The admitted waiting time standard is 90% and applies to admitted adjusted RTT pathways. Admitted pathways are the waiting times for patients whose treatment started during the month and involved admission to hospital. These are also often referred to as inpatient waiting times, but include the complete time waited from referral until start of inpatient treatment. The non-admitted waiting time standard is 95%. Non-admitted pathways are the waiting times for patients whose treatment started during the month and did not involve admission to hospital. These are also often referred to as outpatient waiting times, but they include the time waited for patients whose RTT waiting time clock either stopped for treatment or other reasons, such as a patient declining treatment. The incomplete waiting time standard is 92%. The Department of Health introduced this new operational standard from April 2012 onwards. Incomplete pathways are the waiting times for patients waiting to start treatment at the end of the month. These are also often referred to as waiting list waiting times and the volume of incomplete RTT pathways as the size of the RTT waiting list. 4. Referral to Treatment waiting times data collection Referral to Treatment (RTT) data is collected from NHS providers (NHS Trusts and other providers) and signed off by commissioners (Primary Care Trusts). The data measures RTT waiting times in weeks, split by treatment function. The treatment functions are based on consultant specialties. The length of the RTT pathway is reported for patients whose RTT clock stopped during the month. The Department of Health published the RTT Rules Suite on 28 November These documents were updated in January 2012 and can be found at: The data return includes all patients whose RTT clock stopped at any point in the reporting period. A column has been provided to enter data for patients whose length of RTT period is unknown, i.e. patients who have had a clock stop during the month but where the clock start date is not known. For admitted patients, the RTT time is measured on an adjusted basis - from the date the RTT clock starts to the date that the RTT clock stops, allowing for legitimate pauses as described in the above RTT Rules Suite. For non-admitted patients, the RTT time is measured on an unadjusted basis - from the date the RTT clock starts to the date that the RTT clock stops, as detailed in DSCN 17/

6 For patients on incomplete pathways, the RTT time is measured on an unadjusted basis. Incomplete pathways represent those patients who have been referred on to consultantled referral to treatment pathways, but whose treatment had not yet started at the end of the reporting period. These patients will be at various stages of their pathway, for example, waiting for diagnostics, an appointment with a consultant, or for admission for a procedure. 5. Data Availability Data for admitted patients (patients whose RTT clock stopped with an inpatient/ day case admission) has been published each month since January 2007 on an unadjusted basis. Data for admitted patients (patients whose RTT clock stopped with an inpatient/ day case admission) has been published each month since March 2008 on an adjusted basis. Data for non-admitted patients (patients whose RTT clock stopped during the month for reasons other than an inpatient/day case admission) and incomplete RTT times for patients whose RTT clock is still running has been published each month since August RTT waiting times data are published to a pre-announced timetable, roughly 7 weeks after the end of the reference month. Publication occurs on a Thursday and is always on or after the 31st working day after the end of the reporting month. 6. Provider and Commissioner based data Commissioner based returns reflect data on a responsible population basis, which is defined as: all those patients resident within the PCT boundary; plus all patients registered with GPs who are members of the PCT, but are resident in another PCT; minus All patients resident in the PCT, but registered with a GP who is a member of another PCT Provider based returns cover patients for whom English commissioners are responsible. 7. Average (median) waiting times The median is the preferred measure of the average waiting time as it is less susceptible to extreme values than the mean. The median waiting times is the middle value when all patients are ordered by length of wait. This is the midpoint of the RTT waiting times distribution. For completed pathways, 50% of patients started treatment within the median waiting time, and for incomplete pathways 50% of patients were waiting within the median waiting time. 6

7 It should be noted that median times are calculated from aggregate data, rather than patient level data, and therefore are only estimates of the position on average waits. 7. Interpretation of RTT waiting times Care should be taken when making month on month comparisons of these figures. Measures of waiting time performance are subject to seasonality. For example, the presence of bank holidays or the number of weekends in a calendar month both affect the number of working days. Similarly, adverse weather may result in emergency pressure and impacts upon the health service's ability to preserve elective capacity. These factors can affect waiting times and should be considered when making comparisons across time. 8. NHS Operating Framework The operational standards of 90 per cent for admitted and 95 per cent for non-admitted completed waits as set out in the NHS Constitution remain. In order to sustain the delivery of these standards, trusts will need to ensure that 92 per cent of patients on an incomplete pathway should have been waiting no more than 18 weeks. The referral to treatment (RTT) operational standards should be achieved in each specialty by every organisation and this will be monitored monthly. 9. Feedback welcomed We welcome feedback on the content and presentation of RTT statistics within this Statistical Press Notice and those published on the DH website. If anyone has any comments on this, or any other issues regarding RTT data and statistics, then please RTTdata@dh.gsi.gov.uk Additional Information For press enquiries contact the Department of Health Media Centre. Please refer to the Department of Health s website for the relevant contact details: The Government Statistical Service (GSS) statistician responsible for producing these data is: Mark Svenson Knowledge and Intelligence Department of Health Room 8E28, Quarry House, Quarry Hill, Leeds LS2 7UE RTTdata@dh.gsi.gov.uk 7